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Labor and delivery: Pain medications

Scottsdale, Arizona - Many types of medication can ease pain during labor and delivery. Epidural and spinal blocks are common choices - but you have other options, too. Work with your health care team to make the best decision for you and your baby.

Use this guide to learn more about specific medications used during labor and delivery.

Epidural block

Description

An epidural block is a regional analgesic that can be used during labor. An epidural block with more or stronger medications — anesthetics — can be used shortly before a C-section or if a vaginal birth requires the use of forceps or vacuum extraction. You'll be asked to sit or lie on your side with your back curved outward during the procedure. Medication is then injected into a small space outside the spinal cord in the lower back (epidural space). You might be given a test dose of medication to make sure the epidural is positioned correctly. If you don't experience any problems, you'll be given a full dose. It takes 10 to 20 minutes for the medication to take effect.

Pros

An epidural alleviates most pain in the lower body without significantly slowing labor. It can be used continuously throughout labor. You'll remain awake and alert. A walking epidural - a combination of an epidural and a spinal block that might leave you enough muscle strength to walk during labor - is available in some facilities. An epidural block usually has little or no effect on the baby.

Cons

An epidural might affect one side of your body more than the other. An epidural might decrease your blood pressure, which might slow the baby's heart rate. If the anesthesia affects your chest wall, you might have the temporary sensation of difficulty breathing. Because epidural anesthesia can block the ability to empty your bladder, you might need a catheter. Fever and itchiness are possible. Even if you have a walking epidural you might need to remain in bed during labor. Rarely, you might have a severe headache when you're upright in the days after delivery.

Spinal block

Description

A spinal block is a type of regional analgesia that's typically used to provide pain relief shortly before delivery. A spinal block with a stronger medication - an anesthetic - is often used before a C-section. It can also be used if a vaginal birth requires the use of forceps or vacuum extraction. You'll be asked to sit or lie on your side during the procedure. The medication is injected into the sac of fluid below the spinal cord in the lower back and typically takes effect within minutes. A spinal block is commonly combined with an epidural block during labor.

Pros

A spinal block provides complete pain relief in the lower body for about an hour or two. The medication is usually given only once and in a small dose. You'll remain awake and alert. A spinal block usually has little or no effect on the baby.

Cons

A spinal block might decrease your blood pressure, which can slow the baby's heart rate. If the anesthesia affects your chest wall, you might have the temporary sensation of difficulty breathing. Because spinal anesthesia blocks the ability to empty your bladder, you'll likely need a catheter. You might also experience itchiness. Rarely, you might have a severe headache when you're upright in the days after delivery.

Narcotics

Description

Various narcotics - also called opioids - might be used to lessen pain during labor. Narcotics can be injected into a muscle or given through an intravenous (IV) catheter. If you have an IV, you might be able to control your dosage. The medication takes effect in minutes.

Pros

Narcotics decrease the perception of pain for two to six hours and promote rest.

Cons

Narcotics don't eliminate pain. They might cause sleepiness and nausea, and temporarily depress breathing for you or the baby.

Local anesthetic injection

Description

A local anesthetic doesn't help with labor pain but might be used to numb the vaginal area if you need an incision to extend the opening of the vagina (episiotomy) or repair a tear after delivery. The medication is injected into the perineum or vaginal tissue and takes effect quickly.

Pros

Local anesthetics temporarily numb a specific area. Negative effects for mother or baby are rare.

Cons

Local anesthetics don't relieve the pain of contractions. An allergic reaction is possible. Rarely, injecting the medication into a vein might decrease your blood pressure.

Pudendal block

Description

A pudendal block might be used shortly before delivery to block pain between the vagina and anus (perineum). A local anesthetic is injected into the vaginal wall and takes effect in 10 to 20 minutes.

Pros

A pudendal block relieves pain in the lower vagina and perineum for up to an hour. Negative effects for mother or baby are rare.

Cons

A pudendal block might not work or affect only one side of the perineum. An allergic reaction is possible. Rarely, a pudendal block can cause an infection at the injection site, and injecting the medication into a vein might decrease your blood pressure.

Tranquilizers

Description

Rarely, tranquilizers are used to relieve anxiety and promote rest in early labor or before a C-section. They might be injected into a muscle or given through an intravenous catheter and take effect in 10 to 20 minutes.

Pros

Tranquilizers relieve anxiety and promote relaxation for three to four hours.

Nitrous oxide - an odorless, tasteless gas - is an inhalation analgesia that can be used during labor. You administer the anesthetic gas using a hand-held face mask. Nitrous oxide takes effect within a minute. While common in the United Kingdom and Canada, this technique is rarely used in the United States.

Pros

Nitrous oxide alters pain perception. It can be used intermittently or continuously during labor. If you need to have a tear repaired after delivery, you might use nitrous oxide as a supplement to a local anesthetic. Self-administration might give you a sense of control over your pain management. If you become too drowsy, you'll be unable to continue holding the mask to your face and stop inhaling the anesthetic — a built-in safety mechanism. Nitrous oxide has little or no effect on the baby.